Dr. Margaret Chan Director General World Health Organization (WHO) Avenue Appia 20, CH 1211 Geneva 27, Switzerland Dear Director-General Chan, Thank you for meeting with representatives of the International Treatment Preparedness Coalition (ITPC) last month. We are heartened by your words of commitment to Africa , to women, and to primary health care. We are encouraged that you embrace the legacy of Dr. Lee and his understanding of the fundamental importance of universal access to AIDS treatment, care and prevention. So in this letter we write not as adversaries but as persons sharing a common commitment. We still believe that by working together all of us can halt and begin to reverse the spread of HIV/AIDS by 2015. We are gravely concerned that the world has lost the momentum of the 3 by 5 campaign and that WHO is on the brink of squandering its legacy of leadership role in the battle to bring universal treatment access to people living with HIV/AIDS. In this letter we outline five reasons for concern, make six specific demands to be met before the end of 2007 and give four commitments that ITPC will fulfill to do our part in this most critical global effort. Five reasons for grave concern _* 1. Only 26 of over 100 countries have provided targets linked to costed national plans for key HIV/AIDS interventions. This first universal access deliverable was due in December 2006. A 75% failure rate to comply with even the preliminary step makes us seriously doubt that national leadership alone can sustain the momentum for the scale-up of antiretroviral therapy or other interventions. 2. By all accounts, WHO is not sufficiently funded to maintain a strong focus on AIDS treatment scale-up while attending to multiple other critical priorities. Without sufficient funding to fulfill your policy, normative and technical responsibilities on a global, regional and country level, there is no chance that near universal access to AIDS treatment will happen by 2010. 3. The G8 countries have not adequately honored their 2005 Gleneagles commitments to universal access to treatment, prevention and care. 4. Some AIDS policy makers and advocates are pitting treatment and prevention as competitors for resources, rather than understanding that only a comprehensive response that integrates treatment, prevention and care will reverse the pandemic. 5. Parts of the United Nations system and many country governments are not demonstrating the political will to sustain and build upon the momentum and foundations of the 3 by 5 initiative. Six demands for action in the next six months_* 1. All countries must submit by June 30, 2007 their fully costed universal access plans, including yearly targets and budgets.. These plans should not compromise the goal of achieving quantitative 'near universal access', but should also state clearly where there are deficiencies in funding, human resources and health systems capacity. The G8 countries and other donors must then be induced to take specific actions to fill gaps. 2. WHO, in partnership with UNAIDS, must review the treatment scale-up targets and plans, ensure that they are both ambitious and realistic, and declare a single, unified global target for universal access to treatment by 2010 either as 9,800,000 (UNAIDS currently published target) or a number based on WHO-approved cumulative country targets. The Global Fund and PEPFAR each report their own quantitative global results but only WHO is charged to be the focal organization with responsibility and capability to systematically monitor top-level progress against global, regional, and country treatment access and uptake targets. 3. The G8, guided and encouraged by the WHO Director-General, must deliver a funding plan for their commitment to universal access to AIDS treatment, prevention and care at their meeting in Germany in June 2007. This G8 funding plan should include specific resource commitments based on fair share contributions and ensure additional, predictable and sustainable AIDS funding to achieve the universal access goal by 2010. 4. A Universal Access Strategic Planning and Monitoring Group must be set-up as a standing committee of WHO, UNAIDS, the Global Fund, PEPFAR, DFID, representatives of the other G8 countries, developing and middle-income countries, PLWHA networks, treatment activists and organisations representing key populations. It should hold its first meeting by September 2007 and continue to convene and report semi-annually until universal access to treatment, prevention and care is achieved. WHO should assume active leadership for the treatment aspects of the integrated plan. 5. Multilateral, bilateral and private funders must ensure that WHO has the resources to fulfill its mission and leadership role on HIV/AIDS. 6. WHO must ensure that its structures, human resources and performance at global, regional, and country levels are adequate to fulfill its universal access mission with particular emphasis on building on the foundations, lessons learned, and momentum of the 3 by 5 initiative. Regional and country WHO offices especially must be re-organized and strengthened to be fully effective. Specific outcomes should include: a) a robust plan on second line drugs, b) a system to learn lessons in scale up and rapidly share them to improve operations, c) improved technical support to countries to ensure GF and other programs work, d) ensuring that the WHO human resources effort "Treat, Train, and Retain" is fully operational and soon shows concrete outcomes. Four ITPC commitments to ensure demands are met_* 1. Monitoring and watchdogging - we will be active in critiquing, cajoling and supporting WHO and the other multilateral and bilateral agencies. 2. We will partner to get WHO appropriate funding to do what you need to do. 3. Through 'Missing the Target' reporting and grassroots advocacy we will continue our work on country and local levels - pointing out issues, giving solutions and monitoring results. We will meet with you regularly to share our findings with you and your team. 4. We will increase our efforts on treatment literacy - helping people understand that AIDS can be stopped only through integrated programs of treatment, care, support, and prevention. Director-General Chan, we believe that by making access to treatment a core issue of your tenure, you are in a unique position to lead the HIV/AIDS Millennium goal to control the pandemic and to fulfill your priorities for Africa , for women, and for primary health care. We will be at your side in this endeavor. Our lives and the lives of millions depend on it. Please contact any of us for further discussion or comment. Greg Gray, International Coordinator, International Treatment Preparedness Coalition Matilda Moyo, Zimbabwe representing ITPC African Region and Pan African Treatment Access Movement Obatunde Oladapo , Nigeria representing ITPC African Region and Treatment Access Movement Nigeria Rajiv Kafle, Nepal representing ITPC South Asia Region and Nava Kiran Plus Frika Chia Iskandar, Indonesia representing ITPC Southeast Asia and the Asia Pacific Network of PLWHAs Rodrigo Pascal, representing CIAT (ITPC South America) Solomon Adderley, Bahamas representing ITPC Caribbean Region Polly Clayden, UK representing ITPC Western European Region and HIV i-Base Gregg Gonsalves, USA representing ITPC North American Region and AIDS and Rights Alliance for Southern Africa Svilen Konov , Bulgaria representing ITPC Eastern European Region Gregory Vergus, Russia representing ITPC NIS/Baltics Region Representing the International Treatment Preparedness Coalition, a network of over 800 people living with HIV / AIDS and their supporters from 125 countries. Dgroups is a joint initiative of Bellanet, DFID, Hivos, ICA , IICD, OneWorld, UNAIDS